Predictors of permanent pacemaker insertion after mitral valve replacement: A systematic review

Pacing Clin Electrophysiol. 2022 May;45(5):681-687. doi: 10.1111/pace.14484. Epub 2022 Apr 9.


As the established surgical mitral valve replacement (MVR) expands toward various contemporary techniques and access routes, the predictors and burden of procedure-related complications including the need for permanent pacemaker (PPM) implantation need to be identified. Digital databases were searched systematically to identify studies reporting the incidence of PPM implantation after MVR. Detailed study and patient-level baseline characteristics including the type of study, sample size, follow-up, number of post-MVR PPM implantations, age, gender, and baseline ECG abnormalities were abstracted. A total of 12 studies, recruiting 37,124 patients were included in the final analysis. Overall, 2820 (7.6%) patients required a PPM with the net rate ranging from 1.7% to 10.96%. Post-MVR atrioventricular (AV) block was the most commonly observed indication for PPM, followed by sinoatrial (SA) node dysfunction, and bradycardia. Age, male gender, pre-existing comorbid conditions, prior CABG, history of arrhythmias or using antiarrhythmic drugs, atrial fibrillation ablation, and double valve replacement were predictors of PPM implantation post-MVR. Age, male gender, comorbid conditions like diabetes and renal impairment, prior CABG, double valve replacement, and antiarrhythmic drugs served as positive predictors of PPM implantation in patients undergoing MVR.

Keywords: atrioventricular block; cardiac surgery; conduction disturbances; mitral valve disease.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anti-Arrhythmia Agents
  • Aortic Valve Stenosis* / surgery
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / surgery
  • Atrioventricular Block* / therapy
  • Humans
  • Male
  • Mitral Valve / surgery
  • Pacemaker, Artificial* / adverse effects
  • Postoperative Complications / surgery
  • Retrospective Studies
  • Risk Factors
  • Sick Sinus Syndrome / complications
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Treatment Outcome


  • Anti-Arrhythmia Agents